=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912824236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVENANT HOUSE MRDD SERVICES,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2026
-----------------------------------------------------
Last Update Date | 06/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 479 SEYMOUR AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43205-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-309-0395
-----------------------------------------------------
Fax | 614-252-6787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 479 SEYMOUR AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43205-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-309-0395
-----------------------------------------------------
Fax | 614-252-6787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O
-----------------------------------------------------
Name | MR. BOB HENRY DUCKENS SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-561-0390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------